Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | N4579 | TX |
NPI | 1093020117 |
---|---|
Provider Name | Rosabelle Via Mcconkey |
First Address | Houston, TX 77065-4290 |
Second Address | Houston, TX 77065-4290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2010 |
Last Update Date | 12/08/2010 |